Will Shohei Ohtani need Tommy John surgery?

It only took two days for Shohei Ohtani’s elbow injury to go from bad to potentially worse. After the Los Angeles Angels announced on Friday that Ohtani was going on the disabled list with a grade 2 strain of the ulnar collateral ligament in his pitching elbow, the baseball world is now wondering whether he’ll need Tommy John surgery, which could keep him out until 2020.

“The Angels are holding out hope that (Ohtani won’t need surgery), but everything I’m hearing is that the reality is he probably will need Tommy John surgery. They’re trying to hold out because they’re in the middle of a season, they’re kind of competitive right now, he is their best pitcher. But, it doesn’t look good at this point.”

Gomez said that he’s reporting what he’s heard from his sources, so it’s just an unconfirmed report at this point. But considering that Ohtani’s UCL strain has gotten worse over time, it’s not hard to believe that Tommy John surgery could be in his future.

Here’s how Angels GM Billy Eppler responded to Gomez’s report.

#Angels GM Billy Eppler: “There have been no changes in Ohtani’s diagnosis and neither our physicians nor medical staff have recommended (Tommy John surgery) or said it’s likely.”

The Angels announced Friday that Ohtani has a grade 2 sprain of the UCL in his right elbow.

Despite the Angels’ comment, the real gut-punch of the report, besides that he “probably” needs Tommy John surgery, is the time frame. If Ohtani has Tommy John now, he would most likely miss the rest of the 2018 season AND the entirety of 2019 season. The earliest he’d be back would be spring training 2020. That’s 20 long, Ohtani-free months.

Shohei Ohtani left Wednesday’s game vs. the Royals in the fifth inning. (AP Photo)

Ohtani was diagnosed with a grade 1 UCL strain back in November, before he signed with the Angels. The Angels knew about it, and presumably signed off on his recommended treatment: a platelet-rich plasma injection and rest. Ohtani was able to start the season on time, and he performed brilliantly. However, his UCL was continuing to get worse. ESPN Stats and Info tweeted an interesting statistic about UCL injury treatments and Tommy John surgery on Friday.

Shohei Ohtani will be placed on the DL with a grade 2 sprain of the UCL after receiving a PRP and Stem Cell injection. Of the 33 instances of PRP injections for UCL injuries that Jon Roegele has confirmed (since 2008), 16 (48.5%) have ultimately led to Tommy John Surgery.

That stat provides a little hope, but it’s important to remember that Ohtani got a PRP injection in November after his grade 1 strain and in June after his grade 2 strain. After two injections for progressively worse UCL strains, his chances of getting Tommy John might be higher.

The Angels have a little history with UCL strains, though. In May 2016, Garrett Richards had a significant tear of his UCL, but opted for stem cell therapy and rest instead of surgery. He missed the rest of the 2016 season, but was able to start the 2017 season. Masahiro Tanaka of the New York Yankees was also able to avoid surgery to repair his partially torn UCL in 2014, similarly getting a stem cell injection and resting for several months. These two cases are far from the norm, but it shows that it’s possible to avoid Tommy John if the situation is right.

Though Ohtani “probably” needs Tommy John surgery, there’s no harm in waiting to see how things look in a few weeks. When the Angels announced Ohtani was going on the DL, they also said he received a platelet-rich plasma injection and would be evaluated again in three weeks. If he’s going to miss all of the 2019 season no matter what, waiting a few more weeks isn’t going to hurt anything — even if it feels like it’s just prolonging the inevitable.